Left Side Of Face Research Articles

Crossed Pain and Temperature Sensation Disturbance With Peripheral Facial Palsy Due to a Localized Lateral Inferior Pontine Infarction

A 47-year-old man with dyslipidemia abruptly developed pain and temperature sensation disturbance on the left-sided face and right-sided body and extremities, and left-sided peripheral facial palsy. There were not any other neurological symptoms. Cranial magnetic resonance imaging demonstrated a localized infarct lesion in the left lateral inferior pons. The left anterior inferior cerebellar artery (AICA) was demonstrated by magnetic resonance angiography. Consequently, infarction of the left caudomedial branch of AICA might involve spinothalamic tract, spinal trigeminal nucleus and facial nerve . Here, we emphasize that combination of crossed pain and temperature sensation disturbance with peripheral facial palsy is an indicating sign of a localized lateral inferior pontine lesion. J Med Cases. 2014;5(7):397-398 doi: http://dx.doi.org/10.14740/jmc1785w

Aggressive Maxillary Spindle Cell Sarcoma: Case Report

Spindle cell sarcomas are aggressive neoplasias rarely seen in the maxillofacial region. Man, 48, had painless swelling in the left side of face. Computed tomographic scan showed a lesion extending laterally from the ethmoidal to the maxillary sinus and upward from the alveolar bone to the orbit. Incisional biopsy was performed because a malignant lesion was suspected. Microscopic examination revealed a fascicular arrangement of spindle-shaped cells, some with a rounded shape associated with bone invasion. An exaggerated degree of nuclear pleomorphism, mild mitosis, and myxoid pattern were also observed. The patient underwent total maxillectomy, leading to esthetic and functional problems. Immunohistochemistry was focally positive only for anti-actin, myogenin, desmin, AE1/AE3, and gene INI-1 product, but with no predominant immunophenotype. Because of challenges in the differential diagnosis, immunohistochemistry generally helps to elucidate the tumor's origin, but in this case was inconclusive.

Classic porokeratosis of Mibelli.

A 47-year-old homemaker presented with recurrent ulcer over left palm and mildly painful fingertip swelling over left thumb and middle finger for past 1 year. She had noticed ring like skin lesion over her left palm since childhood. There was no family history of similar skin lesion. On examination, multiple annular plaques with central atrophy and keratotic ridge at the margin were seen over left side of face, lips, neck, upper back, abdomen, left forearm and left palm. Over the palm, the keratotic ridge ran over thenar and hypothenar eminence, base of fingers, first finger web space and along the thumb and middle finger causing constriction band with bulbous swelling distally at finger tips [Figure 1]; and nails of the two fingers were dystrophic at the sites adjoining the ridges [Figure ​[Figure2a2a-​-c].c]. Annular plaque with keratotic ridge was seen over the left eyelid margins, left side of lower lip involving the mucosal surfaces of lip and lower eyelid and right side buccal mucosa. However, she did not have any discomfort in the oral cavity or eye. There was fissuring at the site of ridge over thenar eminence of left palm [Figure 1]. On dermoscopy, the ridge of the annular plaques was prominently seen along with a thin groove in the keratotic ridge [Figure 2d]. Radiography of the affected hand revealed distal digital narrowing in the left thumb [Figure 2e]. Histopathology from the ridge showed keratin-filled epidermal invaginations [Figure 3]. There was no evidence of malignancy from the biopsy taken from the fissure or the bulbous projection. Patient was started on acitretin and planned for CO2 laser ablation of the lesions. Figure 1 Plaque with central atrophy and threadlike keratotic ridge at the margin over the palm, first finger web space, along the thumb and middle finger causing constriction band with bulbous swelling distally at finger tips Figure 2 (a and b) dystrophic nails of the thumb and middle finger with adjoining keratotic ridges, (c) keratotic ridge at adjoining sites of thumb and index finger, (d) its dermoscopic image showing the groove in the keratotic ridge and (e) radiographic image ... Figure 3 Keratin-filled epidermal invagination with rising parakeratotic column (H and E ×40) and inset showing higher magnification of keratin filled epidermal invaginations with irregularly arranged keratinocytes with pyknotic nuclei (H and E ×200) ...

JAW CYSTS AND GUIDED BONE REGENERATION (a late complication after enucleation)

SUMMARY Maxillary jaw bone possesses a high regenerative capacity. Yet sometimes the defects enucleation of jaw cysts leaves may regenerate only partially or not at all. For this reason some researchers advise treatment of the residual cavities after cystectomy using bone regeneration stimulation methods. We report a case of an atypical complication after enucleation of a maxillary cyst manifesting itself eight years after the initial treatment. The symptoms the patient reported were at first periodic sweating on the left sides of face and head. This was followed by a piercing pain in the left palpebral fissure radiating to the middle of the palate and felt in the left cheekbone, left eye and left supraorbital ridge. The patient has a history of maxillary cysts recurring three times and of three operations she had 20, 12 and 8 years previously. The multiple recurrences of the cysts after their enucleation indicates poor regenerative capacity of the body which resulted in the formation of cicatricial tissue. It is most probably this tissue that was responsible for the disruption of the nerve conduction capacity which can account for the reported symptoms. We filled the cavity with bone graft material which boosted the bone structure regeneration. Although maxillary jaws possess high regenerative capacity we advise the use of guided bone regeneration in cases of large bone defects that usually occur after enucleation of jaw cysts.

Uncommon Cone-Beam Computerized Tomography Findings in McCune-Albright Syndrome in an Implant Candidate Patient: A Case Report

Introduction: McCune-Albright syndrome is a rare disease, characterized by triad of cafe-au-lait spots, endocrinopathies and fibrous dysplasia. These bone lesions are usually revealed during the first decade of life, together with pain, pathological fractures and secondary deformities. Case Presentation: A 40-year-old female patient presented an opaque lesion at the left mandibular side of face, in a cone-beam computerized tomography (CBCT) view, during the implant placement evaluations. The patient had experienced precocious puberty and had undergone hysterectomy. Unilateral cafe-au-lait spots were present on patient’s left side of the face. There was no expansion in intraoral examination. The oral mucosa was also normal. No asymmetry was detected. The analysis of sample histopathology confirmed fibrous dysplasia. Discussion: In this patient we preferred following up. Afterwards, total surgical lesion resection can be performed. After a long-term follow-up, the area may receive an implant.

Carotid dissection following a generalized tonic-clonic seizure

A 37-year-old woman experienced a generalized tonic-clonic seizure. Subsequent to the seizure, the patient observed left-sided face and neck pain. A left Horner syndrome was noted on examination. An MRI and magnetic resonance angiogram revealed a left skull base carotid artery dissection without infarction (figure, A and B). Previous MRI had shown normal carotid flow voids. The patient was treated conservatively and magnetic resonance angiogram 1 month later revealed recanalization (figure, C).

Facial onset sensory motor neuronopathy: not always a slowly progressive disorder

Facial onset sensory motor neuronopathy (FOSMN) is a rare disorder characterized by sensory deficits in the trigeminal territory associated with weakness and wasting of facial muscles [1]. Symptoms usually spread to neck and upper limb (UL) muscles. Usually, the disease duration is slowly progressive [1, 2]. In past reports, temporary response to intravenous immunoglobulin (IVIG) or plasmapheresis (PE) in some patients suggested an inflammatory pathogenesis [2, 3]. More recently, pathologic studies indicated a neurodegenerative mechanism [4]. We describe a rapidly progressive case of FOSMN mimicking amyotrophic lateral sclerosis (ALS). A 70-year-old man presented to our hospital with left UL weakness. He reported a 1-month history of paraesthesia and numbness in left side of face with loss of taste. Two weeks later, numbness involved scalp and neck. At the admission, neurological examination revealed moderate wasting of temporal and masseter muscles, especially the left ones. Fasciculations were present in facial and proximal limb muscles. He had also moderate weakness of neck flexors and trunk muscles, and slight weakness of left arm abductors and flexors. Pinprick and temperature sensation were reduced in the left trigeminal nerve territory. His general laboratory workup including serum lipoproteins, hormones and autoantibodies was unrevealing. Genetic testing for Kennedy’s disease was negative. Cerebrospinal fluid (CSF) analysis revealed 95 mg/dL protein with no oligoclonal bands. Nerve conduction studies (NCS) were normal, needle electromyography (EMG) revealed fibrillations in the left trapezius muscle and denervation-reinnervation changes in the muscles of the upper and lower limbs. Blink reflex showed delayed responses bilaterally. Motor evoked potentials showed an increase of central conduction time. MRI of the brain and spinal cord appeared normal with no evidence of syrinx or malignant roots infiltration. Because of the CSF protein increase, IVIG (2 g/kg in 5 days) was administered. Few weeks later, the patient experienced a subjective improvement in left UL muscle strength, however his overall condition at neurological examination remained unchanged. Two months after disease onset, facial pain increased, becoming continuous and stabbing. Left facial nerve palsy with severe weakness of neck flexors and moderate involvement of proximal and distal left UL muscles was evident. After 9 months the patient’s clinical condition continued to worsen, despite a five PE protocol. Common analgesics, pregabalin, amitriptyline, carbamazepine, tapentadol and tramadol were used in order to treat pain, with poor results. Weakness spread up to the territory of both facial nerves E. Barca (&) M. Russo A. Mazzeo C. Terranova A. Toscano P. Girlanda Department of Neurosciences, University of Messina, Messina, Italy e-mail: emanuelebarca@hotmail.com

Lateral asymmetry in saccadic eye movements during face processing: The role of individual differences in schizotypy

Healthy individuals with high as compared to low levels of schizotypal personality traits make more first saccades to the left side of faces, suggesting increased right hemisphere (RH) dominance for face processing. Patients with schizophrenia, however, show attenuated or reversed RH dominance for face processing. It is unclear whether the increased RH dominance found in high schizotypes is specific to face processing or whether it is also observable for other stimuli matched in terms of low-level visual properties. We measured gaze to faces and symmetrical fractal patterns and found higher Magical Ideation (MI) is associated with an increased left-side bias for initial saccade landing points and dwell times when free-viewing faces. These laterality biases were unaffected by facial emotion. Schizotypy scores were not related to laterality biases when viewing fractals. Our results provide further evidence that high schizotypy is associated with an increase in RH dominance for face processing.

Follicular Ameloblastoma with Granular Changes Affecting Mandible & Maxilla - A Case Report

Ameloblastoma is defined as a benign but locally invasive neoplasm consisting of proliferating odontogenic epithelium lying in a fibrous stroma. Ameloblastomas are believed to have an epithelial origin, i.e. remnants of the dental lamina, remnants of Hertwig's root sheath (the epithelial remains of Malassez), epithelium of odontogenic cysts (particularly dentigerous cysts) and odontomas, the developing enamel organ and the basal cells of the surface epithelium of the jaws. Here we report a case of follicular cell ameloblastoma in a 45 years old female patient with a chief complaint of pain & swelling over the left side of face since 5 years. H & E stained sections showed stratified squamous hyperkeratotic epithelium with break in the continuity of the basement membrane. The underlying connective tissue contains numerous nests, strands, sheets & islands of dysplastic to atypical epithelial cells suggestive of malignancy in a fibro cellular stroma with little or no inflammatory cell infiltration. Hemimandibulectomy was done including condyle and coronoid process and the tumor mass. A 2.5 mm stainless steel reconstruction plate was fixed for the mandibular reconstruction. There was a marked resorption of the maxillary bone due to tumor expansion but maxilla was not involved directly into the tumor extension.

Opalski’s syndrome: A rare variant of lateral medullary syndrome

Opalski’s syndrome: A rare variant of lateral medullary syndrome

Demyelinating Disease following Anti-TNFa Treatment: A Causal or Coincidental Association? Report of Four Cases and Review of the Literature

Tumor necrosis factor antagonists (anti-TNFa) are an established therapeutic option for several autoimmune and inflammatory bowel diseases. Despite their clinical effectiveness, neurological adverse events have been reported and literature data suggest a potential role of anti-TNFa in the induction of demyelination of the CNS. We present four patients treated with anti-TNFa who developed symptoms suggestive of CNS demyelination. The first patient, a 17-year-old male who received etanercept for psoriatic arthritis for eight months, presented with dysesthesias up to T4 level. The second patient, a 30-year-old male treated with adalimumab for three years due to ankylosing spondylitis, presented with right unilateral tinnitus. The third case, a 47-year-old female, received etanercept for four years because of psoriatic arthritis and developed persistent headache and left-sided face and head numbness. Finally, the fourth patient, a 57-years-old female treated with etanercept for six years due to ankylosing spondylitis, presented with difficulty in speech, swallowing, and ptosis of the right corner of the mouth. In all cases, brain MRI showed lesions suggestive of demyelination, while positive oligoclonal bands were detected in the CSF. Anti-TNFa treatments were discontinued and patients showed clinical improvement with pulsed intravenous corticosteroid therapy. CNS demyelination following anti-TNFa treatment represents a relatively rare but potential serious complication. Close follow-up and MRI monitoring of these patients is mandatory to elucidate whether the clinical manifestations represent adverse events occurring during anti-TNFa therapy or a first demyelinating episode.

Myositis ossificans traumatica of the medial pterygoid muscle: A case report

Object of studyOssification of medial pterygoid muscle is a rare clinicopathological entity due to complication of maxillofacial trauma. We present a case of myositis ossificans traumatica (MOT) of the left medial pterygoid muscle that has developed following repeated maxillofacial trauma. MethodA 31-year-old male patient was referred to the Division of Oral and Maxillofacial surgery. He sustained panfacial trauma due to road traffic crash in November 2005. He was managed by ORIF for panfacial trauma. He reported again in July 2006 for restricted mouth opening and was diagnosed as a case of fibrous ankylosis of left TMJ. He was treated by interpositional arthroplasty. In May 2008 he again reported with progressive reduction of mouth opening following fall on left side of face. On examination maximum inter-incisal opening was 8mm. A hard and non tender mass was palpable on the left submandibular region which was fixed to the medial aspect of angle of mandible. CT examination revealed calcification of medial pterygoid muscle. Surgical excision was planned. The area was exposed and the ossified muscle was delineated. Mouth opening of 37mm was achieved. Specimen was sent for histopathological examination. Histopathological examination confirmed the diagnosis of myositis ossificans of the medial pterygoid muscle. ResultPatient has been followed up for 30 months and has improved mouthopening. ConclusionDiagnosing the condition is very challenging. There are no established treatment protocols for MOT as the literature is unclear about the need for surgical intervention, surgical timing, recurrence rates, and effectiveness of nonsurgical therapies.

Juvenile psammomatoid ossifying fibroma of maxilla causing dysarthria, dysphagia and dyspnoea

Juvenile psammomatoid ossifying fibroma [JPOF] is a well defined clinical and histological entity with earlier onset [childhood or adolescence] classified under the broad category of fibro-osseous lesions. Histologically it is one of the entity of juvenile ossifying fibroma [JOF] characterized by small spherical ossicles resembling psammoma bodies and the other with trabecular or fibrillar osteoid and woven bone which is termed juvenile trabecular ossifying fibroma [JTOF]. This case of JPOF involved maxilla, premaxilla, antrum, lateral wall of nose on left side of face. The size, extent and aggressive behaviour of the tumour have led to facial disfigurement leading to dysarthria, dysphagia and postural dyspnoea. The treatment done by resection with safe margins was adequate. The patient is under follow up for more than one year.

Multi-Angle Face Detection Using Back Propagation Neural Network

In machine vision application, the main part to analyze an image is to identify its features which contribute to efficiency of the system. Many applications in vision system and image analysis used face detection as a feature of their whole system development. In application such as video surveillance, fatigue detection and security system, face is a fundamental step in the analysis before proceed to system implementation. It is very challenging to recognize a face from an image due to the wide variety of face and the uncertain of face position. In this paper, we propose a neural network based approach to identify multi-angle face which falls into five categories: all left-side face, half left-side face, positive face, half right-side face, and all right-side face. More than 100 images of each category have been used for training and testing of face detection and its features was extracted to be an input to BP neural network. We analyzed the result of training and testing set of neural network and the best classification achieved was 90.7%.

Milia-like papules on upper trunk, neck, and left forehead

A 60-year-old man presented with a 3-month history of a mildly pruritic skin eruption on his upper chest, back, and left side of face and neck. He had a history of carcinoma ex pleomorphic adenoma of the parotid gland with metastases to the thyroid gland and neck and axillary lymph nodes. The patient was initially treated with surgical removal of the parotid and thyroid glands and lymph node dissection. Since the treatment, the patient has had difficulty with lymphedema affecting the left arm and chest.

A case of circumscribed choroidal hemangioma in Sturge-Weber syndrome in China.

We present a case of circumscribed choroidal hemangioma (CCH) in Sturge-Weber syndrome in a 30-year-old woman with congenital port-wine stains on the left side of face involving the upper eyelid, cheek and the nose, and she had undergone facial hemangioma surgery 3 years ago suggestive of Sturge-Weber syndrome. She presented with a 1-month history of rapidly decreased visual acuity (VA) to counting fingers in the left eye which had no prior history of visual problem. And there was no evidence of glaucoma. At 3 months after the treatment of the standard photodynamic therapy (PDT) the VA was 20/200. For some reasons, we have no idea about the changes of tumor thickness and subretinal fluid. We confirmed the curative effect of PDT treatment for CCH because of the significantly improved VA in the bad eye.

Diagnostic and Surgical Challenge in the Management of a Rare Tumor of Skull Base and Face

ABSTRACTAimWe report a rare case of lateral skull base hamartoma. The diagnostic dilemma, the therapeutic challenge and the importance of interdisciplinary approach to decrease the morbidity has been discussed.MethodWe report a rare case of a 48-year-old male with swelling over the left side of face and cheek for a duration of 12 years, who presented to us only for his cosmetic deformity and no functional impairment, after a thorough clinical examination and series of invasive and noninvasive investigations, was diagnosed to have a rare tumor hamartoma of skull base and face. A complete surgical excision without morbidity was made possible only by a multidisciplinary team approach. The investigation and surgical approach to reduce per operative morbidity has been discussed. Microscopic examination of the excised specimen with special staining techniques was conclusive for hamartoma. Patient has been on a regular follow-up for the last 2 years with no evidence of recurrence and functional compromise.DiscussionThe rarity of the tumor, the difficulty in diagnosis, management and prognosis of hamartoma have been discussed.ConclusionHamartoma of the infratemporal fossa is a rare tumor and those originating in this surgically challenging site are even rarer. Further their close proximity to vital structures in head and neck poses a formidable challenge in their diagnosis and surgical management to achieve a good cosmetic and functional result.

Pure Sarcomatoid Carcinoma of Maxillary Sinus and Nasal Cavity Simulating Malignant Fibrous Histiocytoma

Although a few cases of sinonasal carcinoma with focal sarcomatous differentiation have been reported, pure sarcomatoid carcinoma has not been reported in the English literature. Imaging studies and gross inspection in a 60-year-old man with left-sided face pain revealed a mass in the left maxillary sinus and nasal cavity. A large incisional biopsy specimen from the nasal cavity revealed proliferation of malignant spindle and round cells with a malignant fibrous histiocytoma (MFH) pattern. Tumor giant cells were scattered, and there were areas of a vague storiform pattern. Mitotic figures were numerous. Carcinomatous component was not recognized. The histologic diagnosis was storiform-pleomorphic MFH. Tumor cells were positive for pancytokeratins AE1/3, KL-1, and CAM5.2 and cytokeratin (CK) 18, vimentin, CD68, p53, Ki-67 (labeling, 90%), α₁-antitrypsin, and α₁-antichymotrypsin and negative for pancytokeratin WSS, CK 34βE14, CK7, CK8, CK14, CK19, CK20, epithelial membrane antigen, S-100 protein, desmin, α-smooth muscle actin, CD34, HMB45, chromogranin, synaptophysin, myoglobin, CD45, CD30, and CD15. Because keratins were positive in tumor cells, a diagnosis of sarcomatoid carcinoma simulating MFH was made. The patient was treated with chemoradiation without significant effect and died 9 months after initial examination.

PSAMMOMATOID OSSIFYING FIBROMA-AN UNUSAL PRESENTATION

Psammomatoid juvenile ossifying fibroma (PsJOF) is a well defined clinical and histological entity with earlier onset at (childhood or adolescence) classified under the broad category of fibro-osseous lesion. Histological PsJOF is one of the entity of juvenile ossifying fibroma (JOF) characterized by small spherical ossicles resembling psammoma bodies and the other with trabecular or fibrillar osteoid and woven bone which is termed as trabecular juvenile ossifying fibroma (TrJOF). This case of PsJOF involved maxilla, premaxilla, antrum, lateral wall of nose on left side of face. The size, extent and aggressive behavior of the tumor which has lead to facial disfigurement and difficulty in breathing, inability to speak, eat and drink is rare in literature. The treatment done by resection with safe margins is adequate with no recurrence as patient is under follow up for more than one year.

Facial muscle activation patterns in healthy male humans: A multi-channel surface EMG study

In order to accurately characterize essential muscle activity during facial movements a new surface EMG (SEMG) technique was introduced and applied. Results represent reference data of healthy persons for future diagnostic purposes. In 30 healthy males monopolar electromyograms of the facial muscles were simultaneously recorded from 48 bilateral-symmetrically applied small surface electrodes while performing 29 facial movements of high clinical relevance. Mean SEMG amplitudes were quantified by power spectral analysis, normalized and presented as movement-related SEMG profiles. The mean SEMG amplitudes increased significantly in response to facial movements. Critical values of the movement-related SEMG amplitude increase were ascertained, valid for 90% of all examined subjects. The mean SEMG amplitudes differed between the performed facial movements, the examined muscles, and intramuscularly between lateral–medial and superior–inferior electrode positions, but not systematically between right and left side of face. The results show that the interplay between individual facial muscles and intramuscularly between their functional subunits is more differentiated than was previously estimated. With the presented facial SEMG technique the produced SEMG profiles are highly relevant for better planning of facial movement restoration. Based on the established reference data, this method can be used to objectively evaluate a facial paresis and to monitor changes during the course of disease and treatment. To easily apply the method, a reduction of electrode positions is intended after the clinical evaluation.